Health Objectives for the Nation
Selected Characteristics of Local Health Departments --
United States, 1992-1993

A year 2000 national health objective is to increase to at
least 90%
the proportion of persons who are served by a local health
department
(LHD) that is effectively performing the core functions of public
health
(objective 8.14) (1). A framework for examining essential roles and
services of LHDs is critical to developing a surveillance system to
monitor progress toward this goal (2-4). To characterize the
activities,
staff, expenditures, and jurisdictions of LHDs in the United
States,
during 1992-1993 the National Association of County and City Health
Officials (NACCHO), in collaboration with CDC, surveyed all LHDs.
This
report summarizes the services provided by LHDs by population of
the
jurisdiction, the expenditures and staff to support these services,
and
type of jurisdiction.

For this survey, an LHD was defined as "an administrative or
service
unit of local or state government concerned with health and
carrying some
responsibility for the health of a jurisdiction smaller than the
state."
LHDs were identified from the 1990 NACCHO Profile database (5)
through a
review of NACCHO member mailing lists and inquiries to selected
state
health agencies. The questionnaire was mailed in November 1992 to
LHDs in
49 states and the District of Columbia (Rhode Island had no LHDs
meeting
the study definition). Three follow-up mailings and telephone calls
were
made to nonrespondents. Data collection ended in December 1993.

Overall, 2079 (72%) of the LHDs that met the study definition
(n=2888) returned completed questionnaires. The estimated total
population
served by the responding LHDs was approximately 85% of the 1990
U.S. total
(249 million); 1710 (82%) respondents served jurisdictions with
populations less than 100,000, and 369 (18%) served jurisdictions
with
100,000 or more.

Program planning. Resources used by LHDs to guide program
planning
included Healthy People 2000 by 70%, Healthy Communities 2000 Model
Standards by 47%, the Assessment Protocol for Excellence in Public
Health
by 32%, and the Planned Approach to Community Health by 12%.

Agency services. The percentage of LHDs reporting activity in
specific services generally increased in relation to the size of
population served by the LHD. In addition to community prevention
services
Table_1, substantial numbers of LHDs provided clinical
prevention and
health-care services Table_2. Overall, 57% of LHDs reported
they had
conducted evaluations to determine whether a gap existed between
available
clinical prevention services and a need for these services in their
jurisdictions. Of these LHDs, 83% reported the provision of
clinical
prevention service programs to address the gaps.

Personnel and budget. In general, LHD staff and annual
expenditures
increased in relation to the population served: for the 82% of LHDs
serving less than 100,000 persons, the median number of full-time
staff
was nine, and the median annual expenditure was $350,000. In
comparison,
for the 18% of LHDs serving 100,000 or more, the median number of
full-time staff was 94, and the median annual expenditure was $4.5
million.

Jurisdictional units. Geographic areas served by LHDs were
single
county (56%), multicounty districts (11%), city (7%), city/county
units
(13%), and town or township jurisdictions (11%).
Reported by: C Brown, N Rawding, D Custer, National Association of
County
and City Health Officials. Div of Public Health Systems, Public
Health
Practice Program Office, CDC.

Editorial Note

Editorial Note: The findings from this survey of LHDs are being
used to
develop plans for a surveillance system for the year 2000 national
health
objective 8.14 and may be used as a baseline for evaluating
potential
changes in the role of LHDs associated with changes in the U.S.
health-care system. For example, recent proposals have described
the
primary role for LHDs as the providers of surveillance, health
planning,
and community prevention programs; responsibilities for clinical
prevention services and health-care services currently performed by
LHDs
potentially might be addressed through managed care or other
health-care
providers (2,4,6).

The findings in this survey are subject to at least two
limitations.
First, the results cannot be directly compared with the 1990 NACCHO
Profile (5); because the set of respondents for this survey varied
from
the 1990 survey, temporal trends can be evaluated only by analyzing
the
subset of respondents that participated in both surveys. Second, no
definitions or criteria were provided for reporting services, and
the
scope, quality, and quantity of services were not verified.

Subsequent analyses by NACCHO and CDC will examine the subset
of
respondents who participated in the surveys in both 1989 and
1992-1993.
Related efforts include development of scientifically valid
measures of
the effectiveness of public health agencies (7,8). Before
implementation
of a national surveillance system for the year 2000 national health
objective 8.14, methods must be developed to measure whether a
community
and its LHD are effectively performing the core functions of public
health. Specifically, methods are needed to determine means for
creating
and maintaining a healthy community (3); assess the effectiveness
of
community-based prevention services, programs, and policies (9);
measure
the contribution to public health performance made by community
providers
and agencies other than LHDs; develop a community health "report
card"
(4); and compare the public health performance of different
communities
and their LHDs.

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